Upload
dr-rajan-r-patil
View
108
Download
3
Tags:
Embed Size (px)
DESCRIPTION
The current study on the health status of fishing communities was undertaken by Dr. Rajan R Patil specifically to provide policy inputs into the ongoing fisheries project ‘Supporting Development of sustainable livelihoods in the Fisheries Sector in Orissa” undertaken by United Nations Development Prorgramme (UNDP) in collaboration with Government of Orissa.
Citation preview
HEALTH STATUSOF
FISHING COMMUNITIES With Special Focus on Orissa
A Review Report by
Dr. Rajan Patil
Consultant
United Nations Development Programme
Bhubaneswar, Orissa
1
Introduction
The current study on the health status of fishing communities was undertaken specifically
to provide policy inputs into the ongoing fisheries project ‘Supporting Development of
sustainable livelihoods in the Fisheries Sector in Orissa” undertaken by United Nations
Development Prorgramme (UNDP) in collaboration with Government of Orissa.
The study process involved reviewing secondary data sources from academic institutions,
Government departments and visits to the Health care facilities in coastal districts. The
review was largely confined to health issues related to the marine fishing communities. A
non governmental perspective was taken by inviting NGOs and activists to provide their
inputs in a consultative meeting.
The aim of review was also to understand over all health problems and issues concerned
to well being of the fishing communities in general. Some of the gaps in understanding
the health issues of fisherman communities in Orissa and non availability of data was
over come by referring to specific studies carried out outside Orissa.
Since the duration of the present study was limited to three months, the review does not
claim to be exhaustive but is meant to give a broad based understanding of the health
status of fisherman communities.
2
Table of Contents Page
1. GENERAL MORBIDITY IN FISHING COMMUNITY 5
Prevalence and distribution of diseases. Health Seeking Behavior among fishing community. Socio Medical Factors Associated With Infectious Disease in Fishing Community Reduced Risk of Cardiac Disease with fish diet
2. NUTRITION 7
Low Birth Weight Malnutrition Nutritional Deficiency disorders Anemia Anthropometry Social determinants of Nutrition4
3. MATERNAL AND CHILD HEALTH ISSUES 10
Breast feeding practices Immunization Coverage Of Children By Gender In Fishing Community Age Specific Fertility Rates Of Fisherman Community Causes of Infant Mortality in fishing community
4. ENVIRONMENT HEALTH 13
Toxic algae Risk of Infection from sea Coastal Pollution
5. OCCUPATIONAL SAFETY AND HEALTH 14
Gap analysis Physical Vulnerability Occupational Health Risks Addictions among Fishing Community
6. INJURY 183
Results of an ILO survey on health and safety issues Causes of Accidents Human factor considerations in traditional fisheries
7. INSURANCE COVERAGE 22
8. HEALTH CARE SERVICES IN FISHING COMMUNITY 23
Health Services Deficiencies As Documented By NGO In Ganjam OTFWU Perspective of Health Services Government Health Care facilities in 6 coastal districts in Orissa
9. BIBLIOGRAPHY 27
1. GENERAL MORBIDITY IN THE FISHING COMMUNITIES
4
Health studies specifically in fishing communities are very scarce not only in Orissa but
also across India. Even those who have attempted to study health issues among fishing
communities, have not published their works, or at the most have put there work on
internet. The current review of health status among the fishing community was done
mainly through unpublished documents available with academic institutions and
government departments.
Table-1 Prevalence and distribution of diseases among the fisherman communities
as seen from different studies in Orissa and Pondicherry. (Figures in percentages)
CONDITION
Keuta study 2001 [1]
Gopalpur 1986 [2]
OTFWU* Findings [3]
PHC data
Pondichery study [4]
Injury 4.6 17.2 2.7
ARI 2.3 5.3 4.5 11.6
Skin 19.3 40.8 5.8 96
Diarrhoea 10.5 1.8 3.3
Worm infection 5.4 5
Hypertension 3.7 3.6 1.2
Malaria 3.6 4
Vita A deficiency 1.2 3
Anemia 56.2 3.6 0.8
RTI 12.96 7.8
Gastritis 4.3 11.5 10.6
Fever 24.5 22.8 0.5
Body pain 5.8 18.4
Ear 1.5
Low back pain 49.7 6.9
Eye disease 5.8
Endocrine disease 0.4
nervous system 0.4
Gentio-urinary 0.4
Filariasis 0.2
Cardio vascular 4.4
* Orissa Traditional Fishermen Worker Union
5
A close look at the findings of these studies show that disease profile of the fishing
community reflect the health problems that are peculiar to lower economic sections of the
society.
Typically, diseases due to lack of hygiene and nutrition are prominent e.g. Skin disease,
worm infection, diarrhoea and Acute Respiratory Infection. Nutritional problems like
Vitamin-A deficiencies are common across various fishing communities
Table-2. Health Seeking Behavior among fishing community [2]
Only 20% of fishing communities are availing Government health care services, while
over whelming majority dependent on private health care sector. Making them
vulnerable for further exploitation
Socio Medical Factors Associated With Infectious Disease in Fishing Community
Occurrence of two of the major morbidity condition of children viz Acute Respiratory
Infection and diarrhoea were further analysed on the basis of various socio medical
factor, The incidence of ARI diarrhoea were found to be statistically significant with
Source of Treatment Proportion
availing services
Govt Hospital21.1 %
Outside Hospital 14.9 %
Private practitioner 41.7 %
Health supervisor (M) 1.3 %
Lady Health visitor 3.5 %
ANM 6.3 %
MPW M 11 %
6
Higher birth order, higher household size, lower maternal education, poor IDCS
attendance and lower birth weight.
Reduced Risk of Cardiac Disease with fish diet
Studies indicate that People with a diet rich in fish, have a reduced risk of suffering a
heart attack. This is likely to be due to specific actions of fish oils and the research will
look at the way this is achieved. The data indicate that eating of fish may have role in
ameliorating the risk of coronary heart disease. [5]
Raynaud’s disease
Handling different sorts of tasks from slicing, shelling to hardening and processing a
variety of marine products including squids and seaweed etc by the fisherwomen soon
make them prone to various health problems. The problems range from back pain and
protein related asthma to Raynaud’s phenomenon a disorder that affects the blood vessel
in the fingers toes ears and nose.
2. NUTRITION
Dietary Habit
1. The food pattern of fishing communities imply that the total calories consumption
of the under five children were, low but not for protein. The situation is explained
by the fact that the family consumption of the seafood was high. This problem is
somewhat different situation compared to non coastal area where low protein
intake is general picture in the low income families.
2. Food intake by Pre School children fishing communities were observed to be
inadequate when compared to dietary requirements. This might be because of
poor economic status, low literacy and lack of nutritional awareness of the mother
and lack of time for the mother to attend on the children. Such low intake may
lead to affect cognitive function, mood and behavior of children. [1]
7
3. The mean intake of cereals by the preschool children in the surveyed fishing
communities was found to be 136gms/day, pulse intake was 9.8 gm and milk
consumption was 66gm and poultry was 16.8 gms where as fish intake was 34
grams. [7]
Low Birth Weight
1. Prevalence of LBW among the fishing community was 76.4 %, and babies born
with healthy weight is only 23.6%.
2. The majority of infant mortality in the fishing community occurred among low
birth weight babies accounting for 97% to total infant deaths, while only about
3% of infant deaths occurred in healthy babies. [8]
The national average of low birth weight is around 30% [9]
Malnutrition
1. Prevalence of malnutrition was 57.2% (Grade-1 32.6% + grade II-16.9% & grade
III 5.2%) [1]
2. Prevalence of Malnutrition in four southern coastal district was found to be 67.5
% (Grade I=42.5%+Grade II=19.5%+ Grade 3 =6.5%) [7]
3. Prevalence of stunting in the 0-5 years age group of fisherman community was
44.1%. [7]
When we look at malnutrition of children in general population 54.4 per of children
suffer from malnutrition. Prevalence of stunting was prevalent in 44 percent of children.
[10]
8
Nutritional Deficiency disorders
69.2% of women in fishing community in four southern states were anemic. Other
clinical symptos like anglura stomatis, chelosis, bleeding gum and dryness of skin ranged
from 25%-30%.[7]
In general population, 48% of women in Orissa were found to be suffering from
nutritional deficiency. [10]
Anemia
Prevalence of anemia in pre school children was 31% and other nutritional deficiency
signs were noticed in 35% of children. [7]
The reason for high anemia might be due to low consumption of iron rich foods,
maintenance of poor health hygiene and sanitation also due to lack of nutritional
awareness
There is a high presence of anemia in lactating women (69.2 %) [7]
Anthropometry
Anthropometric measurements of fisher women showed a mean weight 48.5kg, height
was found to be 150cm and their BMI was found to be 21.3. Forty-nine percent of
women were normal, 17% were below low normal, 10.5% were mildly nourished and 4%
were moderately malnourished and 2.9% were severely malnourished. Only 11.5% were
overweight and 4.6% were obese.
The mean weight of school Children was found to be 12.7kg. Majority (41%) of the
children were in grade-1 category of malnutrition, 32% were in normal grades, 19% were
9
in grade-2 category of malnutrition and the remaining were grade-3 category of
malnutrition. [7]
Social determinants of Nutrition
The combined effect of insufficient food supply and of forced postponement of taking
food late in the evening would further reduce the nutritional status of females. This would
increase chance of females getting sick leading to lower life expectancy and longevity.
Observed lower female well being can also be the outcome of a low bargaining process
where female’s self interest perception assigns lower value to her own well being. This is
the case if the females have an agency role so that welfare of the family outweighs her
own personal interest [11]
3. MATERNAL AND CHILD HEALTH ISSUES IN FISHING COMMUNITY
Lack of Antenatal/Post Natal Care
Lack of Antenatal care in fishing community can be seen in its effect on Infant
mortality, with 62 % of Infant deaths in fishing community occurred in women who had
not availed antenatal services, while 29.7% occurring in women having irregular Ante
Natal Care [ANC]. While only 8% of infant mortality had occurred among the Infants of
women who had taken regular ANC. [1]
All the Interventions aimed at reducing maternal morbidity are linked to attendance to
ANC. Hence lower coverage of ANC will lead to lower utilization of Iron Folic Acid
[IFA] and Tetanus Toxide (TT] injections , with 6.4% and 40.4% of women received TT
and IFA respective among women who had not availed ANC care. [8]
Post natal care was received only by 21.4% of lactating women by lactating women.
If we look at ANC coverage in Orissa as a state, the coverage of antenatal care was rather
impressive with 73.4 percent of women had received some ante natal care. [10]
10
Breast feeding practices
1. Lack of awareness about importance of Breast feeding among fishing community
as noted by 72.9% of infant mortality occurring in children who were partially
breastfed. [8]
2. Large proportion i.e., 81% of fisherwomen children were weaned at the age of 8
months and it was the food cooked for other family members and never bothered
for special foods and sometime preferred to give banana
3. 42.2% of infants were not being breast fed. [8]
Table-3. Immunization Coverage of Children by Gender In Fishing Community in Orissa [2]
FEMALE FEMALE
BCG DPT POLIO BCG DPT POLIO
36.6 % 25.6 % 24.7 % 31.8 % 33.6 % 27.5 %
Immunization coverage among fishing communities was found to be very low.
Communities with Immunization coverage lesser than 80% will not have herd immunity
due to which they are at high risk to experience disease outbreaks.
High Maternal Morbidity
1. Maternal morbidity was wide spread with 78.7% of mothers had some or other
morbidity eg anemia, pelvic inflammatory diseases, or reproductive tract
11
infections. 75.6% of infant deaths was noted when mothers had one or other
morbidity during pregnancy. [8]
2. Anemia is very common with 69.2% of lactating women had anemia but only
58.6% were taking Iron Folic Acid (IFA) tablets
3. There was difference in gender with male children getting better coverage
indicating gender bias.
Table-4. Age Specific Fertility Rates Of Fisherman Community in Orissa [2]
Age group Fertility rate
(fishing community)
Fertility Rate
(urban India)
15-19 142.8 41.9
20-24 300 192.1
25-29 272 190.5
30-34 160 133.4
35-39 97 70.0
40-44 62 24.1
45-49 - 6.8
It can be seen in the table that fertility rate is high in all the age groups among fishermen
as compared to urban India figures. The main reasons for the higher fertility rate among
fishing communities could be due to lower socio-economic status and lack access to
family welfare programmes by the government
12
Table-5 Causes of Infant Mortality in fishing community [8]
4. ENVIRONMENT HEALTH
Toxic algae
Certain marine algae produce potent toxins that impact human health through the
consumption of contaminated shellfish and finfish and through water or aerosol exposure.
Over the past three decades, the frequency and global distribution of toxic algal incidents
appear to have increased, and human intoxications from novel algal sources have
occurred. This increase is of particular concern, since it parallels recent evidence of large-
scale ecologic disturbances that coincide with trends in global warming. [12]
Risk of Infection from sea
A number of bacterial, viral and other diseases can be contracted by man through
exposure to sewage-polluted bathing-water or beach sand. The increasing use of the sea
for recreation has led to major concern regarding health hazards to both local and tourist
populations. [13]
Berhampur 03 study-
Orissa state
GIPMER study
LBW 45.90
Diarrhoea 18.9 1.8 5.7
respiratory 16.2 24.1 20.4
septicemia 10.8
prematurty 38.5 18.2
Birth Injury 2.90%
Congenital 2.7
13
Coastal Pollution
Coastal pollution by sewage is still a major concern and control measures vary
considerably. A number of microbiological/epidemiological studies have been carried out
since 1953 in an attempt to define the levels of risk following exposure to different
concentrations of bacteria in bathing waters.
Discharge of sewage to sea and any resultant threat to human well-being is just one of
man's effects on coastal waters. The associated health effects of bathing in coastal waters
holds a high place on the public agenda. It has been recommended that the sewage should
only be discharged to sea after screening, and through long sea-outfalls. They also set
down three prerequisites for such discharges: sewage particles should not be able to reach
bathing areas; point of discharge should be remote enough from the shore to prevent the
slick causing offence to people onshore or in bathing beaches Domestic sewage
discharged in coastal waters contains a particularly unhealthy mix of both harmless and
infectious microorganisms. [14]
5. Occupational Safety and Health
In a study ranking job group in Norway based on occupational injuries reported to
insurance companies, fisheries had the their highest annual cost per worker
A Study has revealed incidence rate of 7.6 injuries per 1000 workers per year. The
highest injury rate was found in the 20-29 years age group.
The highest number of injuries occurred from November to March and in May.
Bruises, fractures, cuts and sprains were the most frequent injuries among the
fisheries workers. Bruises and cuts represented a higher proportion of injuries
compared with other occupations.
The study also showed that Injury rates decreased with age. In fisheries workers
above 30 years, injuries were most frequent during winter months and were more
disperse over hours of the days of the week than in other occupation. Falls and
14
machine related accidents were common, resulting most often in injuries to hands
and fingers, chest and abdomen. [15]
Gap analysis
There are no occupational health services for fishermen and, in contrast to the oil
industry there is no mandatory health screening. This is largely due to self
employed status of many workers.
Fatal accident rates of fishermen were noted to be 20 times greater that those of
coal mines.
Only two studies have looked into fatalities with specific causes. One of them was
study on fatal poisoning in industrial fishing and another was on air composition.
[16]
Physical Vulnerability
Living and working space on board the boats are very limited. That does not
leave much living and working space. Cramped crew accommodation can result
in fishermen living very close to each other and this may increase stress as well as
increased risk of communicable disease.
Risks vary with each type of fishing operation, area of operation, boat size,
equipment carried and the job of each fisherman. On larger boats, the risk of
being killed or injured through crushing by heavy equipment may be relatively
high.
On small and artisanal boats, the risk of capsizing from a snagged trawl, sinking
while pulling in a large catch and even being attacked by dangerous marine life
can be considerable.
15
Bad weather, unsuitable boats are additional risks, perhaps greater for small boats
than larger ones. Smaller crafts are more vulnerable to get damaged or lost in
powerful storms or run down by merchant ships.
The external environment may be seen as the cause (bad weather) or an accident
may be attributed to the human element (inattention, fatigue, lack of training).
Causes may be described in very general terms used for all professions (falling
from height, slipping) or be specific to fishing (caught in trawl winch). They can
be categorized under various headings, including by boat size
Occupational Health Risks
A sick or injured fisherman must depend on receiving immediate medical care
from other members of the crew; if fishing alone, the only help available must
come from himself or from nearby fishing boats, if at all. Fishermen on artisanal
craft may not have a radio to call for help.
Fishermen also suffer from skin and respiratory diseases, effects of noise and
vibration. Hypertension, coronary heart diseases, stomach cancer and lung cancer
are also indicated as important problems. Some diseases, such as salt-water boils
and injury by or allergic reactions to marine life are peculiar to fishing.
Common problems include occupational asthma, hearing loss, fatal poisoning and
asphyxia, skin diseases, cancers of the lip, lung and stomach. Occupational
asthma was associated with several types of fish but mostly with crustaceans and
mollusks. Fatal poisoning was often related to the inhalation of toxic fumes
caused by fires on board. Asphyxiation or poisoning occurred due to the lack of
oxygen or the build-up of toxic gases in enclosed spaces. Skin diseases were
related to handling fish or other marine life without using gloves. Lip cancer (and
skin cancer) is probably the result of excessive exposure to the sun. Lung cancer
may be related to excessive smoking among fishermen. It may also relate to the
use of asbestos and other materials in machinery spaces. Other health problems
may include eye damage from excessive glare from the sun and irritations 16
resulting from standing for long periods or sitting for long periods on cold
surfaces. [17]
Table-5. Prevalence of Addiction among Fisherman Community [2]
Addiction Male Female Both
Nil 43.5 52.7 47.8Alcohol 53.5 28.1Smoking 53.5 2.3 29.2Tobacco chewing 53.5 42.9 48.5Ganja 2.3 1.2Opium 0.7 1.9 1.3
As can be seen from the table close to more than quarter of the fishing community are
addicted alcohol which apart from being direct health hazard, also make them prone to
accidents and injuries very often leading to death. Tobacco addiction is also significantly
high in the fishing community with more than three fourth of fishermen addicted to
various forms of tobacco.
Results of an ILO survey on health and safety issues in the fishing sector
1. The results indicated that the most frequent work-related injuries in fishermen
were: superficial injuries, effects of weather and exposure, injuries to the
musculoskeletal system, contusions and crushing injuries, and near drowning.
2. Drowning was a leading cause of death among fishermen.
3. The leading types of accidents were: stepping on, striking against or being struck
by an object, falling, overexertion.
4. The leading causes of accidents were: rough weather, fatigue, poor technical
condition of the boat, inadequate or inappropriate tools, equipment, personal
protective equipment and inattention.
5. The most frequent diseases among fishermen were: skin and respiratory diseases,
and the effects of noise and vibration on board the boat.
17
6. In morbidity statistics and publications hypertension, coronary heart diseases and
cancer of the lungs, bronchus and stomach were also mentioned as frequently
diagnosed diseases.
7. Some diseases are specific to fishermen, such as salt-water boils, allergic
reactions to cuttlefish and weeds, fish erysipeloid, acute tenosynovitis of the wrist,
conjunctivitis and poisonous fish stings of certain fish in the warm waters of the
tropics and subtropics.
8. In the majority of countries, medical and health care for fishermen has been
organized. They are required to be medically examined prior to taking up their
occupation, and later on at regular intervals, as required by law and regulations.
9. Medical staff (doctors and/or nurses) are employed in some countries to
accompany the crews of large trawlers, factory ships or auxiliary ships (bases) to
oversee their health. Otherwise, masters or officers are trained in medical matters
and provide first aid and basic health care during the boat's voyage. Medical
equipment and supplies are carried on fishing boats, and use is made of the
International Medical Guide for Ships or an equivalent national publication. Ships
are in contact with medical radio stations on shore and, if necessary, casualties
can be transported to shore for hospital treatment, if the distance from shore
allows it.
6. Injury
There is not only a great variety in fishing operations but also a great variety in the way
fishing safety and health problems are qualified and quantified. For example, deaths and
injuries can be related to boat casualties or to personnel accidents not involving loss or
damage to the boat; they may be attributed directly to one cause (e.g. drowning) or
indirectly to other causes (capsizing of boat, falling over the side).
Accidents may be attributed to a primary event or an underlying or primary cause; they
may be associated with certain types of fishing (trawling, long lining) or to certain types
of equipment (winches, fishing gear).
18
A comparison between fatality statistics in the fishing industry and general occupational
fatality rates of other occupational categories shows that fishing is one of the most
dangerous professions.
Fatalities
In Australia, between 1982 and 1984, the fatality rate for fishermen was 143/100,000
person-years compared to 8.1/100,000 generally; in Denmark, from 1989 to 1996, the
rate was 25-30 times higher than the rate for those employed on land; in the United States
in 1996, the death rate was estimated at eight times that of persons operating motor
vehicles for a living, 16 times higher than such occupations as fire-fighting and police
work and over 40 times the national average; in China, over 400 fishermen are reported
killed in accidents each year; in Tunisia in 1994, the rate was double the national average.
The ILO's Occupational Safety and Health Branch estimates that fishing has a worldwide
fatality rate of 80 per 100,000 workers or approximately 24,000 deaths per year, and
estimates that there are 24 million non-fatal accidents in the sector every year.
Fatal accidents in small-scale artisan/traditional fishing
Artisanal and other small-scale boats often operate with less than adequate safety and
communication equipment, first aid, search and rescue (SAR) and early warning services.
In Guinea, a small country with some 7,000 artisanal marine fishermen, a survey
disclosed that during one year every 15th canoe has an accident, and for every 200
registered fishermen one person (male and female fishermen, fish traders and their
families) dies in a canoe accident. In Oceania, during the 1989-90 period, some 120
deaths in about 640 accidents were reported. This picture becomes worse still when the
sometimes massive losses of life and equipment in tropical storms are taken into
consideration.
Most fishing boats are too small to be fitted with accommodation ladders. In harbors with
a rise and fall of the tide, access to boats is normally by ladders indented into the pier
19
with steel rungs. These rungs are sometimes twisted or, even worse, missing. Due to the
common method of mooring the boats in parallel, the fisherman then has to cross several
boats to reach his own. Such a traverse is risky even in daylight under normal
circumstances. When a fisherman returns to his boat at night (in some cases under the
influence of alcohol), in the darkness with no one else around, such an obstacle course
can be fatal [17]
Non-fatal accidents
Non-fatal accidents are common in the fishing industry. The body regions most
frequently injured include the hands, lower limbs, head and neck and upper limbs,
followed by the chest, spine and abdomen. The most common types of traumas are open
wounds, fractures, strains, sprains and contusions. Many non-fatal injuries may involve
amputation of fingers, hands, arms and legs as well as injuries to the head and neck.
Infections, lacerations and minor traumas of the hands and finger are quite frequent.
Information on the Russian fleet reveals that hands were injured in 41 per cent of
accidents, legs -- 29 per cent, wrists -- 18 per cent, head and neck -- 10 per cent. A 1995
Swedish study concluded that hands and wrists were the most exposed body parts
followed by shanks or knees and lower arms or elbows. Others categorize accidents
according to the nature of the injury sustained. For example, a study of lost-time
accidents covering 10,475 Polish deep-sea fishermen from 1977 to 1986 recorded that the
most frequent types of injuries were: contusions and crushing 25.2 per cent, fractures --
24.4 per cent and wounds 17.7 per cent.
Causes of Accidents
There are different approaches to examining the causes of accidents, but all have the
same general objective -- to understand what factors, or series of factors, led to a casualty
or accident, in order to prevent them in the future or mitigate their effects.
20
The IMO has collected information from member States on the primary causes of
casualties which led to the death of fishermen The table divides primary causes into a
number of categories covering both boat and human factors.
Human error, fishing gear incidents and adverse weather appear as important primary
causes in the accidents reported to the IMO. As will be seen later in this report, new
investigation techniques are helping investigators obtain a better understanding of what
causes accidents [17]
Human factor- determinants for safety in traditional fisheries
In long-standing traditional fisheries, fisher folk have inherited time-proven responses to
crises at sea, survival strategies and weather perception that, along with their fishing
know-how, evolved through ages of operating traditional technology under specific, local
conditions. However, the introduction of modern technologies into traditional systems
has in many cases upset the traditional ways of doing things, not always for the better.
Lack of appreciation of the limits of modern technology has led to the taking of undue
risks (e.g. assuming the outboard motor will always work). This is often exacerbated by
shortcomings in technical training in engine operation and maritime training in
navigation, in the use of electronic aids and safety equipment, and in first aid and
behavior in emergencies.
There is also a loss of traditional knowledge not only due to the shift to unfamiliar
technologies but also to changes in the age composition of crews. Old, experienced
fishermen for various reasons stay ashore more often. Young fishermen may not only
lack the traditional survival skills and equipment but may also feel less vulnerable to
accidents than their elders who, though less skilled in operating modern machinery, have
more experience in the marine environment.
Another factor is a mistrust of modern weather forecasting systems and, perhaps even
more so, of those who convey the information. A warning from a shore side official with
no fishing experience may not be believed. For example, when the deadly November
1996 cyclone surprised the Kakinada coast in India, messengers issuing the warnings
were met in some places with derision by fisherfolk who could not discern the usual 21
storm-indicating signs in the sky and sea. On the day of the cyclone, fishing boats out
taking good catches did not anticipate bad weather and would not heed the radio
warnings to take shelter [17]
7. Insurance Coverage
On reviewing presently available Insurance schemes (by govt), found that they are
largely life insurance schemes wherein benefits are available only in extreme events i.e.,
death or permanent disability e.g. Group accident insurance for fishermen (no premium is
charged, but only men are eligible), Janashree bimayojana (fisherman pays Rs100/pa
+Orissa govt puts in Rs 100 per annum).
The objective of the scheme is to provide life insurance protection to the rural and urban
poor persons below poverty line and marginally above the poverty line.
Eligibility: A person who is aged between 18 and 59 years. Below or marginally above
poverty line A member of any of the approved vocation/occupation groups
Nodal Agency: A State Government Department which is concerned with the welfare of
any such vocation/occupation group, a Welfare Fund/ Society, Village Panchayat, NGO,
Self-Help Group, etc.
Minimum Membership Size: Twenty five.
Saving Cum Relief Scheme
This Scheme is initiated to help fisher folk community to tide over their off season period
or lean period of 4 months by providing subsistence when they can not go out into sea for
fishing
Under this scheme Rs 75 is contributed by the fisherman per month for 8 months, thus
contributing Rs 600 per year, Govt of Orissa contributes Rs 300 and Govt of India
contributes rupees Rs.300
22
Community Health Insurance
There is no comprehensive health insurance for fishing community presently available in
Orissa.
General mortality rate during the five year period was 42 thousand in fishing
Communities and 26percent for the non fishing communities in Orissa as indicated by a
study by Bay of Bengal programme. [18]
8. HEALTH SERVICES IN FISHING COMMUNITIES
Deficiencies in Health care services as documented By NGO In Ganjam [19]
1. Low percentage of routine immunization (48%).
2. Lack of pre and post natal services resulting in high IMR and MMR.
3. Low percentage of Birth Registration (16%).
4. Irregular growth monitoring and care feed is mostly misappropriated.
5. Families are forced to have recourse to traditional healer (59%).
Lack of Potable Water and Sanitation.
a. Fresh water crisis for children to bathe and drink
b. Children are suffering from water born diseases (60 % worm infestation and
scabies – School Health checkups).
Lack of Critical Consciousness.
1. Proper care and development of individual children is affected due to lack of
family planning (75 % of mother are not using any family planning method)
2. 30% of mothers have knowledge on Diarrhoea Management.
3. 84% of children have no Birth Registration.
4. 52% of the Children have not received complete immunization.
23
OTFWU Perspective of Health Services In Arjipally Ganjam
• One PHC (new) is situated near one of the project villages.
• 4 villages do not have a sub-center.
• Nearest PHC/ Government health center is about 15 kilometers from Ramey
Patna and 4 kilometers from the Arjyapalli.
Gaps in Health services
• Health workers occasionally visit the villages generally on immunization days.
• There are Quacks/ RMPs provide health care to the people and charge very high
fees
• Villages are not connected by public transport system. So at the time of
emergency people find difficulty in transporting patients to the hospital and
forced to see the village based quacks.
Government Health Care facilities in 6 coastal districts in Orissa
Access to specialised medical care to fishing communities is very limited. The sector
PHCs which are single doctor PHC do not provide in-patient care (admit patients) hence
services like surgical and obstretical care are not available at sector level. Hence, fishing
community will have to depend on Block PHC hospital for these vital health care services
but the access to block PHC is limited by long distances which is generally more than 20
kms.
Tabel-6. Government Health Care facilities in Coastal districts of Orissa
Hospital CHC PHC PHC (N) MHU TOTALGanjam 13 10 15 83 121
Jagatsinghpur 2 4 4 36 46Kendrapara 2 7 2 44 55Bhadrak 4 6 1 49 60Puri 11 5 6 43 65Balasore 6 6 8 66 86
24
Table-7. Average distance of Government health care facilities from fishermen villages:
Note. Average Distance from Sector PHC to Individual fisher folk villages would be
about 7-10 km. This distance would need to be covered from fishing villages while
accessing Block PHC Hospital
DISTRICTBLOCK PHC HOSPITAL
SECTOR PHC
DISTANCE from Block PHC
DISTANCE VILLAGE TO BLOCK PHC HOSPITAL*
Jagatsingpur Kujang Malanunka 5km Average distance of fisherman village to Block PHC hospital
20- 25 kms
Pankapal 10km Raham 15km Potanai 18km Gorada 20km Hansura 23km Ersama Ersama Average distance
of fisherman village to Block PHC hospital 25-30 Kms
Balitut 22km
Panchupalli 20km Bhadrak Basudevapur Basudevapur Ertal 10km Average distance
of fisherman village to Block PHC hospital
20-25 kms
Betada 8km Eram 12km Balimed 23km Naikanidhi 22km Kendrapada Rajnagar Dangmahal 35km Average distance
of fisherman village to Block PHC hospital
35-40 kms
Wastia 10km
Hq Rajnagar
25
Bibliography
1. Subrat Kumar Pradhan. A study on the health status of women (of reproductive
age group) and children (less than six years of age) of fisherman (keuta)
community of Ganjam, South Orissa. MD thesis, department of Community
medicine. Berhampur university 2001.
2. Gantayat MM. Medico-Socio Profile of Fisherman Community of Gopalpur on
Sea. MD thesis, department of Community medicine. Berhampur University
1986.
3. Mangaraj Panda. Orissa Traditional Fisherman worker union (OTFWU). Consultative Meeting On Health And Related Issues Of Fisher Folk Communities In Coastal Districts Of Orissa. Image, Siripur, Bhubaneswar, Orissa. January 31st
2006.
4. Jaishankar.T.J. Distribution of certain diseases among fishermen in the
Pondichery-A comparative study.Jawaharlal Institute of Post Graduate Medical
Education and Research, Pondichery.2003.
5. Reduced Heart disease risk in fish eating communities
http://www.nutraingredients.com/news/ng.asp?id=37603-fatty-fish-for Eskimos
heart disease.
6. PK Nag. National Institute of Occupational Health, Ahmedabad, India
7. Proceedings of the workshop on empowerment of fisher women in coastal
ecosystem of Andhra Pradesh, Karnataka, Kerala,and Tamilnadu. Hyderabad
October 2003
8. Snigdha Patnaik, an Epidemiological study of Infant Mortality in coastal villages
of Ganjam district. MD thesis, department of Community medicine. Berhampur
University 2003.
26
9. Park S. Text book of Preventive and Social Medicine. Sixteenth ed. Banarasidas
Bhanot. Jabalpur, 2000.
10. Human Development Report. Government of Orissa. 2004
11. Pushpagandhan K Murugan. Gender Bias in Marginalized Community: A study
of fisherfolk in Coastal Kerala. Working paper No.302. Centre for Development
Studies. Tiruvantapuram. May 2003.
12. Van Dolah FM Marine algal toxins: origins, health effects, and their increased
occurrence. Environ Health Perspect . 2000 Mar;108 Suppl 1:133-41.
13. Saliba LJ , Helmer R. Health risks associated with pollution of coastal bathing
waters. W orld Health Stat Q. 1990;43(3):177-87
14. Health Implications of Sewage in Coastal Waters: The British Case Rees, G
Marine Pollution Bulletin MPNBAZ, Vol. 26, No. 1, p 14-19, January 1993. 1 fig,
3 tabs, 27 ref.
15. Bull N, Riise T, Moen B.E.. Occupational Injuries to fisheries workers in Norway
reported in Insurance companies from 1991 to 1996. Occup Med. Vol 51. 2001
16. Matheson C et al. The Health of Fishermen in the catching sector of the fishing
industry :a gap analysis. Occup Med. Vol 51, 2001.
17. Report for discussion at the Tripartite Meeting on Safety and Health in the
Fishing Industry Geneva, 13-17 December 1999
http://www.ilo.org/public/english/dialogue/sector/techmeet/tmfi99/tmfir3.htm
18. V Bhavani. Food and Nutrition status of small scale fisher folks in India’s East Coast states. Bay of Bengal Programme.FAO,1988.
27
19. PREM. Consultative Meeting On Health And Related Issues Of Fisher Folk
Communities In Coastal Districts Of Orissa. Image, Siripur, Bhubaneswar, Orissa. January 31st 2006.
List of Additional Documents Reviewed
20. Consultative Meeting On Health And Related Issues Of Fisher Folk Communities In Coastal Districts Of Orissa. Image, Siripur, Bhubaneswar, Orissa. January 31st
2006.
21. ISRD. Consultative Meeting On Health And Related Issues Of Fisher Folk
Communities In Coastal Districts Of Orissa. Image, Siripur, Bhubaneswar, Orissa. January 31st 2006.
22. Spanish Red Cross. Consultative Meeting On Health And Related Issues Of Fisher
Folk Communities In Coastal Districts Of Orissa. Image, Siripur, Bhubaneswar, Orissa. January 31st 2006.
23. Lakshmi J et al. Nutritional Status of Fisherwomen. Proceedings of the
workshop on Empowerment of fisher women in coastal ecosystem of Andhra
Pradesh, Karnataka, Kerala and Tamilnadu. ANGARU Auditorium,
Rajendranagar, Hyderabad. October 2003.
24. Dhanpal K et al. Nutritional Status of preschool children. Proceedings of the
workshop on Empowerment of fisher women in coastal ecosystem of Andhra
Pradesh, Karnataka, Kerala and Tamilnadu. ANGARU Auditorium,
Rajendranagar, Hyderabad. October 2003.
25. Dhanpal K et al. Anthropometric Measurement of fisherwomen and preschool
children. Proceedings of the workshop on Empowerment of fisher women in
coastal ecosystem of Andhra Pradesh, Karnataka, Kerala and Tamilnadu.
ANGARU Auditorium, Rajendranagar, Hyderabad. October 2003.
28
26. Lakshmi J et al. Clinical & nutritional status of women and preschool children
Proceedings of the workshop on Empowerment of fisher women in coastal
ecosystem of Andhra Pradesh, Karnataka, Kerala and Tamilnadu. ANGARU
Auditorium, Rajendranagar, Hyderabad. October 2003.
27. Lakshmi J et al. Knowledge, Aptitude and Practice (KAP) of Nutrition, Health
and Hygiene of Fisherwomen. Proceedings of the workshop on Empowerment of
fisher women in coastal ecosystem of Andhra Pradesh, Karnataka, Kerala and
Tamilnadu. ANGARU Auditorium, Rajendranagar, Hyderabad. October 2003.
International Labour Office Geneva. Safety and Health in the Fishing Industry
28. Report for discussion at the Tripartite Meeting on Safety and Health in the
Fishing Industry Geneva, 13-17 December 1999
http://www.ilo.org/public/english/dialogue/sector/techmeet/tmfi99/tmfir3.htm
29. Li YS , He YK, Zeng QR, McManus DP. Epidemiological and morbidity
assessment of Schistosoma japonicum infection in a migrant fisherman
community, the Dongting Lake region, China. Trans R Soc Trop Med Hyg. 2003
Mar-Apr;97(2):177-81.
30. Grainger CR . .Some mortality data for Grimsby "lumpers" and fishermen. : Bull
Inst Marit Trop Med Gdynia. 1992;43(1-4):51-5.
31. Thummachinda S , Kaewpongsri S, Wiwanitkit V, Suwansaksri J.. High urine
ttMA levels among fishermen from a Thai rural village. Southeast Asian J Trop
Med Public Health. 2002 Dec; 33(4):878-80.
32. Tewari R , Parikh R , Saha PN Occupational workload of fisherwomen in India. J
Hum Ergol (Tokyo). 1998 Dec; 27(1-2):17-21
33. Li YS , He YK, Zeng QR, McManus DP.. Epidemiological and morbidity
assessment of Schist soma japonicum infection in a migrant fisherman
29
community, the Dongting Lake region, China. Trans R Soc Trop Med Hyg. 2003
Mar-Apr;97(2):177-81
34. Grainger CR . .Some mortality data for Grimsby "lumpers" and fishermen. Bull
Inst Marit Trop Med Gdynia. 1992;43(1-4):51-5.
35. Thummachinda S , Kaewpongsri S, Wiwanitkit V, Suwansaksri J . High urine ttMA
levels among fishermen from a Thai rural village. Southeast Asian J Trop Med
Public Health. 2002 Dec;33(4):878-80.
36. Tewari R , Parekh R, Saha PN. Occupational workload of fisherwomen in India J
Hum Ergol (Tokyo). 1998 Dec;27(1-2):17-21.
POLICY RECOMMENDATIONS FOR IMPROVING THE HEALTH OF
30
FISHER FOLK COMMUNITIES
The low quality of life (on the average) of Fisher folk community and the higher
occupational risks (both to human life and productive assets) that set marine fishing
communities apart from the other occupational groupings. Social security measures attain
paramount importance for them. Fishermen are at greater disadvantage compared to other
communities which require close attention.
The following sets of recommendation are directed to improve general well being of
fisherfolk community and also their occupational health.
Promotion of Family welfare programme
Incidence of Acute Respiratory Infections has significant association with house hold
size, birth order, and birth weight. There is a need to promote family planning and family
welfare programmes in the fishing community.
It is observed that there is higher morbidity pattern and increased Infant mortality in
larger families. This is because larger families usually have overcrowding, poor
environment and more economic burden than smaller families.
Strengthening Anganwadi centres
ICDS attendance helps in proper immunization and Vitamin-A prophylaxis which are
important strategies for reduction of incidence of Acute Respiratory Infections and
blindness. There is need for close coordination with WCD department for improving
utilization of services provided by the Anganwadi centres to the fishing communities.
Improving Sanitation & Hygiene
31
Large scale worm infestation problems among children under 6 years age indicate that
there is gross lacking of sanitary environmental, hence there is a need for emphasis on
environmental hygiene
Control of malaria to reduce infant mortality
Malaria in Pregnant women predisposes to low birth weight & preterm babies which
subsequently impact on high infant mortality.
Better Housing and Habitat
The importance of housing/shelter to the fishing community can not be overemphasized
in the context of physical protection it provides; in addition it has direct bearing on the
health of fisherman as it is associated with incidence of infectious diseases.
Morbidity in the fishing community is found to be influenced by the per capita
income, large family and housing and living condition.
High mortality rates are observed where housing conditions are substandard
overcrowding is a health problem in human dwelling. It promotes spread of
respiratory infections such as influenza and diphtheria.
Diarrhoea is shown to be associated with house hold size hence the emphasis on
provision of shelter to the fisherman community.
Improving the Quality of Maternal and Child health Care
Increased access to Antenatal Care
High prevalence of anemia in pregnant & lactating women in the fishing
community poses a major concern. This is compounded by figures revealing that
close to half of the lactating women in fishing community had not even received
32
antenatal check ups. Hence extending good ante natal care to fishing community
will improve safe motherhood and there by child survival.
There is a clear association between infant mortality rate and lack of antenatal
care. It is also observed that poor quality of ante natal care had an adverse effect
on the fate of the infant.
Increased access to Postnatal Care
Different studies have shown that there is very low utilization of post natal care in the
fishing communities. The Post natal period is very important period in life of women
where many important health tips can be rendered and acceptance by them is very high.
Therefore due steps should be taken for rendering adequate post natal services among the
fishing community.
Sensitization of mothers to Health Services
As the literacy status of the mother bears a direct relationship on the health of the child,
simultaneously, health education must be imparted to this section of women regarding,
family planning, maternal and child health services of utilization and post natal care.
Early detection and prompt treatment of Reproductive Tract Infection
The Maternal morbidity during antenatal period such as reproductive tract infection,
anemia and pelvic infections etc has significant impact on infant mortality.
Better access to Health care Services
Maternal morbidity is strongly associated with poor medical care especially during labor
and child birth. About 70% of maternal morbidity is avoidable. Non existent and
inadequate health care for pregnant mother results in the death of the child.
33
Addressing the Anemia problem in women
Anemia is a major contributing factor in 20-40 percent of maternal death ascribed to child
birth and puerpureum every year. Similarly overall health and development of children
born to anemic mother is less favorable by a factor of 20-40% that of infant born to
normal mother.
NUTRITION
Promotion of exclusive Breast feeding
Breast feeding was predominant practice, but it was not exclusive in nature.
Simultaneously weaning was not carried out at proper age in fishing community. These
factors play adverse role on the growth and development of children which is revealed by
the fact that more than half of children were malnourished as per IAP classification.
Promotion of Hygiene and sanitation
The socio-environmental factors have also been chronic in nature in the fishing
community due to which more than half of children of 3-5 years had features of stunting.
Widespread prevalence of anemia, diarrhoea and ARI in children in fishing community
amply points to the existence of malnutrition –infection vicious cycle
In the fishing communities the prevalence of wasting gradually increased as age
increased and simultaneously stunting was also maximum after 36 months of age. This
points out that the fact that in the study area due to low socio economic status, ignorance
in sanitary conditions the combination of acute on chronic malnutrition is widely
prevalent in the fishing community.
Supplementary feeding
34
Children of 1-3 years of age face the maximum hazards of under nutrition. Therefore
there occurs no further increase in the number of malnourished children. The role of
ICDS in distributing supplementary nutrition to all the children between 3-6 years
becomes paramount.
Early management of malnutrition
Although the most vulnerable period of development of malnutrition is between 6 months
to 18 months, the impact on the general health of the child is left behind, though out the
childhood which is affected with respect of weight and height.
Promotion of Family welfare activities
Nutrition status of children is also related with family size as children belonging to
families with 5 and above number of children had more nutritional disorders.
Increase consumption of cereals.
Protein intake is not a problem in fishing communities as seen in other low income
communities. However totals calories intake in the fishing community is low.
Nutritional education
Considering high prevalence of Anemia in fishing community, there is need for imparting
nutritional education and importance of taking IFA tablets.
LOW BIRTH WEIGHT
Care during pregnancy
35
The incidence of low birth weight children in the fishing communities was found to be
very high as compared to national average of 30%. Low birth weight deliveries must be
viewed as an index of the status of our public health in general and of maternal health in
the coastal regions.
NFHS survey shows the low birth weight babies are at 2.5 times higher risk of dying in
infancy than normal weight babies.
Reduction of Infant Mortality
Infant mortality serves as vital indicator on socio demographic developments of the
communities. The studies reveal that neonatal mortality accounted for nearly 3/5 th of all
infant deaths and low birth weight and prematurity have attributed to nearly half of
causes of infant death. Some key intervention strategies that could be taken into account
for reduction of infant mortality in the study area as follows
1. Intensive communication measures to achieve social mobilization for effective
utilization of maternal and child health services so as to decrease the incidence of
low birth weight.
2. Improvement of basic health infrastructure and creation of facilities for
community level care of the new born. This can be carried out by establishing a
designated home for the provision of natal services in each village and placement
of trained birth attendant so as to ensure clean delivery practices and provide
essential new born care such as keeping the child warm, encouraging exclusive
breast feeding etc.
3. A concentrated effort must be taken up to achieve Intersectoral coordination to
have a better impact on reduction of infant mortality. Along with the health
department, involvement of other departments especially Panchayat raj and
36
education departments is highly essential in the present situation. Establishment
of ICDS services in the area, which is a non ICDS block will not only decrease
infant mortality but also to achieve the overall health and development of the
fishing community
Different studies have revealed that though mother and child are taken as one unit due to
their physiological vulnerabilities to the factors affecting their health, the MCH situation
of the area needs to be further strengthened. Appropriate social mobilization measures
and timely health education services is very much essential for the betterment of health of
fishing community.
Studies in the fishing community show that while the children less than 6 years of age
nearly coincided with national average, where as women in reproductive age group were
less than the national average. This difference shows that in the fisherman communities
child population is more which could be due to large family size and it is here by
indicative towards a community of low socioeconomic status and ignorance of the felt
health needs.
Recommendation for Reducing and prevention of Sexually Transmitted Infection
[STIs] & HIV infection in fishing community
Primary Stake Holders
1. Instead of Targeted Group/ High Risk Group approach in dealing with STIs, it
would be better to have a unified communication system/program for the entire
community to be addressed.
2. Along with formal behavioral change communication it is also important for the
fishermen folk community to be reinforced /engaged with the IEC messages
through outdoor visibility (information Kiosk, Wall paper, poster, paper etc.)
3. Having a clear cut STI management structure.
37
4. The emphasis should be on Syndromic management than specific disease
treatment
5. Intensive behavior change communication for entire community
Secondary Stake Holders in STI/HIV programme
Change of attitude towards STI/HIV among following groups
Quacks,
Key informants,
Godowns /processing plants,
Transporters,
labor contractors,
leaders of people’s group (cooperative /SHG/Apex bodies, Hoteliers 8 Liquor
shops
Innovative ways of sensitization programmes eg. One minute game where winner will
say something on HIV/STI
Tertiary Stake Holders in STI/HIV programme.
Integrate and converge all the available resource from CBOs, NGOs, Govt Organization
Recommendation for improving General Health and Sanitation in fishing
community
1. Creation of Community health Fund among fishing community
2. Greater PRI involvement especially for environmental sanitation and hygiene.
38
3. Establishing of drug depots or medicine points among fishing communities.
4. Provision of Mobile Health units for health care in the fishing community
5. Cultural barriers and strong superstitions need to be tackled e.g., Role and
Guniyas
6. Uninterrupted provision of potable water supply to fishing community so that
they do not use saline water for their daily use.
7. Food habits of fisher folk communities largely consist of rice and smoked fish
with salt which is inadequate to meet all the nutritional requirements.
8. Promotion of personal hygiene especially daily bath and nail cutting among
fishing community.
9. Reducing Vulnerability of fishing community to natural hazards /disaster like
Cyclone, flooding, storm surge etc due to their proximity to coastal line
10. Increasing the accessibility and utilization of government health services among
fishing community
11. Reducing gender disparity in fishing Community will go a long way in improving
health status of fishing community
12. Health care services should be made more gender sensitive.
13. Improving woman participation in all the levels of decision making
OCCUPATIONAL HEALTH
39
With fishing communities, there is difficulty in defining or tracing the population at risk.
A mobile and often self employed group with various length of time spent at sea and
between the trips, registration and certification of all fisherman will help in reaching out
and addressing the issues related to this community.
The registration system death in fisherman group is deficient, creation of Marine
Accident Investigation Branch could overcome this problem as all the deaths at
sea could be recorded and investigated.
Attempts to reduce work related ill health among fishermen needs to be based on
principles of identifying and eliminating or reducing risks.
Search and rescue team especially trained under the DRM Programme especially
in the coastal areas should be effectively utilized for rescuing people caught in
fishing related emergencies.
While in sea, fisherman will not have access external help during emergency; it is
extremely essential that they are trained in First aid to tide over the medical
emergencies at least until they reach shore..
The design construction, maintenance and operation of boats all directly affect
safety and health. Hence there should be monitoring mechanism in place to look
into this issue.
Accurate Weather forecasting is extremely essential for fisherman to balance
between safety and livelihood.
Provision of simple radio instruments to the fisherman would help in immediate
reaching
40
Considering the dangers involved with being in sea and risk of boat capsizing
provision of Survival equipments and life jackets could be considered.
Provision of First aid kits in every boat.
Regular Safety/mock drills for fisherman would help in preparedness and
responding to emergencies.
Adherence to ILO recommendation for improving health and safety of fisherfolk
community.
ILO convention prescribes the adoption of a coherent national policy on occupational
safety, occupational health and the working environment. This Convention calls for :
Etablishing basic principles governing employers' responsibilities at the level of
the undertaking (such as the provision of a safer workplace, adequate protective
clothing and equipment, and measures to deal with emergencies and accidents,
including adequate first-aid arrangements);
it provides that arrangements made at the level of the undertaking should ensure
that workers take certain actions (such as reasonable care, compliance with
instructions, use of safety devices and protective equipment, reporting hazards to
supervisors and reporting accidents and injuries)
The occupational safety and health measures should not involve any expenditure
for the workers
The measures of protection, such as guarding of machinery, medical examination,
and maximum weight of loads to be transported by a single worker.
Protection against specific risks, such as ionizing radiation, benzene, asbestos,
prevention of occupational cancer, prevention of air pollution, noise and vibration
in the working environment and safety in the use of chemicals, including the
prevention of major industrial accidents.
Recording and notification of occupational accidents and diseases.
41
The last of these represents an attempt to develop the basic requirements for the
collection, recording and notification of reliable data on occupational accidents, diseases
and related statistics.
Active coordination with the International Occupational Safety and Health
Information Centre is a worldwide service dedicated to the collection and dissemination
of information on the prevention of occupational accidents and diseases. It is assisted in
its work by over 120 national institutions around the world (its national and collaborating
centres) which deal with Occupational Safety & Health matters in their own countries.
Medical Examination of Fishermen
No person should be engaged for employment in any capacity on a fishing boat unless he
produces a certificate attesting to his fitness for the work for which he is to be employed
at sea. The certificate is to be signed by a medical practitioner who shall be approved by
the competent authority. Exemptions are possible, under certain conditions, for boats not
normally at sea for more than three days. It provides that the competent authority is to
prescribe the nature of medical examinations and the particulars to be included in medical
certificates. There are special requirements for persons less than 21 years of age. There
are provisions for further examination by a medical referee in the event a certificate is
refused to a fisherman.
International Medical Guide for Ships
The International Medical Guide for Ships aims to enable users to diagnose and treat
injured and sick seafarers; to serve as a textbook on medical problems for those studying
for a certificate in medical training; and to help in giving crews some training on first aid,
and on the prevention of diseases. It covers most types of injuries and illnesses
experienced at sea., Diseases of fishermen, provides advice related to such diseases.
Some countries require the Guide, or a national equivalent, to be carried on board.
Hours of Work
42
This Recommendation recalls a declaration in the Constitution of the ILO that all
industrial communities should endeavor to adopt, so far as their special circumstances
will permit, "an eight hours' day or a forty-eight hours' week" as the standard to be aimed
at where it has not already been attained. It recommends that member States should enact
legislation limiting in this direction the hours of work of all workers employed in the
fishing industry, with such special provisions as may be necessary to meet the conditions
peculiar to the fishing industry in each country and, in framing such legislation, to consult
with the organizations of employers and workers concerned.
Fatigue at work
Fatigue is seen to result in the degradation of human performance and the impairment of
rational decision-making and thus has implications for the overall safety of the boat and
for all personnel. Reference is also made to a new appendix, which contains information
on fatigue and the classification of factors contributing to it. All concerned in the
operation of the boat should be aware of the contributory factors and how the effects of
fatigue can prejudice the safe operation of the boat. The skipper, senior officers and other
personnel having a supervisory role should be able to recognize the development of
fatigue among the fishing boat's personnel.
Minimum Age (Fishermen)
This Convention stipulates that children under the age of 15 years shall not be employed
or work on fishing boats. It provides that children may occasionally take part in the
activities on board fishing boats during holidays, subject to certain conditions (namely,
the activities are not harmful to their health or normal development, are not such as to
prejudice school attendance, and are not intended for commercial profit). There are also
exceptions for work on training boats, provided the work is approved and supervised by a
public authority.
Injuries Prevention
Young fisheries workers are at particular high risk of occupational injuries, which can
potentially be prevent by better on the job training, closer follow up of experienced
workers and reduced demands for efficiency from beginners.
43
Training and risk awareness
Adequate training would seem to be a prerequisite for working in such a
dangerous profession.
Generally speaking, the larger the boat, the higher the requirements for the
training and certification of fishermen.
Lack of training contributes to many stability-associated accidents, Insufficient
training is also a reason for some crews' ignorance of means and ways of dealing
with emergencies such as fire on board or taking water. The fishermen of a small
fishing boat need to be trained to negotiate heavy seas and strong currents
Training takes time. At sea, training (e.g. safety drills) may be seen as interfering
with fishing operations or rest periods; ashore, time spent training may be viewed
as unpaid work which is also keeping fishermen from precious time with family
and friends. Training can also be costly, and government funding may be difficult
to obtain. Despite these difficulties training programme should be taken up.
Training must be credible. Fishermen quickly get a sense of whether or not the
person speaking on safety issues understands them and their problems. If they
believe that what is presented is impracticable, costly or simply not well thought
out, they may not only reject the instructor but also the idea of attending another
training course or programme. Consideration might therefore be given to using
experienced and respected fishermen to conduct training, such as fishermen who
have left the sea due to fishing restrictions, injuries or age.
Many fishermen cannot read. Training materials should be aimed at the education
level of the target group. They should be clear and well illustrated, so they can be
clearly understood by most fishermen.
HEALTH INSURANCE FOR FISHERFOLK COMMUNITY:
1. Increase awareness about need for Insurance among fisher folk community
emphasizing on dangers faced by the fisherman community.
44
2. Shift of emphasis from life insurance to general health insurance schemes to cover
major illness, surgeries and hospitalization.
3. The present insurance schemes to fishing community are only provided by the
government the coverage could be increased by roping in private insurance
companies e g. ICICI Life insurance.
4. Group Accident Insurance should also be modified to cover women, which is
presently restricted to Men folk.
5. Contribution of women folk to the fishing industry should be recognized by
extending the same benefits as of their male counterparts.
6. The present Jana Bima Yojana scheme insists on group coverage but should also
be made available to individuals.
7. By introducing Money back policy schemes will interest fisher folk community
than the present conditional benefits to death and disability.
8. Risk communication should be more effective
9. To create consciousness for his / her family for the Health care.
10. Revitalization of fisherman cooperative societies
Innovations required
1. By low cost yearly non refundable premium
2. Involvement of local civil society organization
3. Intensive door to door campaign for insurance
Hurdles
1. It’s a new concept still to be internalized by fishing community.
2. Lack of awareness towards health and health insurance
3. Local quacks and touts in the business
4. Availability of donor agencies.
45
46